Pharmakotherapie - Kardiovaskuläre Nebenwirkungen von klassischen NSAR und Coxiben

Zusammenfassung

Im Zuge der Diskussion über die kardiovaskuläre Sicherheit der einst medienwirksam als neuer Meilenstein der Schmerztherapie angepriesenen selektiven COX-2 Inhibitoren, die mit den Marktrücknahmen der Präparate Vioxx (Rofecoxib) 2004 und Bextra (Valdecoxib) 2005 gipfelte, geraten nun auch die klassischen NSAR in den Blickpunkt. Wie sicher sind die "altbewährten" NSAR wirklich bezüglich kardiovaskulärer Ereignisse? Langzeitstudien belegen ein mit den COX-2 Hemmern vergleichbares Gesamtrisiko. In der perioperativen Kurzzeitanwendung haben dennoch beide Substanzklassen noch ihren Stellenwert. Sie sollten jedoch auch hier nur nach gründlicher Risikoabwägung und keinesfalls routinemäßig eingesetzt werden.

Abstract

Concerning the current discussion about cardiovascular toxicity of the selective COX-2 inhibitors, recently advertised in the media as a new milestone in the management of pain, culminating in the market withdrawal of the preparations Vioxx (rofecoxib) in 2004 and Bextra (valdecoxib) in 2005, the classical NSAIDs are now spotlighted. How safe are the "well established" NSAIDs regarding adverse cardiovascular events?

Long term studies now show a similar overall risk compared to the selective COX-2 inhibitors. The short lasting perioperative administration of both drug classes are still indicated. However, even here they should be only used after a systematic risk-calculation and not on a routine basis.

Schlüsselwörter:

NSAR - COXibe - Kardiovaskuläre Ereignisse

Key words:

NSAIDs - Coxibs - Cardiovascular events

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